P1654: IS THERE REALLY AN INCREASED RISK IN PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME UNDERGOING TO INVASIVE PROCEDURES?
Authors: Rocio Camacho, Angel Gabriel Vargas Ruiz, Alfonso Orozco Collazo, Mayte Cruz Zermelo, Juan Rangel Patiño
Journal: HemaSphere (2023)

Topic: 34. Thrombosis and vascular biology - Biology & Translational Research Background: Antiphospholipid syndrome (APS) is an acquired autoimmune disorder characterized by thrombosis and obstetric morbidity associated with the presence of serum antiphospholipid antibodies. Due to the hypercoagulable state and the long-term anticoagulation, the complications associated with invasive procedures (IP) are increased. To our knowledge this is the first study describing the complications of patients with APS undergoing IP and it is highly relevant because we can provide solid evidence to establish a guideline for the management of this challenging population. Aims: The primary aim was to evaluate the complications of APS patients that underwent invasive procedures compared to those that had not gone. Methods: We assess the electronic clinical record of all patients diagnosed with APS according to the Sapporo criteria and had chronic use of anticoagulation in one reference center in Mexico City from 1998 to 2018, we separate the cohort in patients that had an IP, defined as all procedures that break any barrer in the body, and those who had not and evaluate demographic data, history of thrombotic events, second thrombotic events, major bleeding episodes, presence of comorbidities and type of anticoagulation of both groups with the primary aim of compare the complications in the two of them. As secondary aims we described the incidence of thrombosis and major bleeding in APS patients as well as the type and number of IP in this population, additionally we trace the clinical scenario and medical management during the periprocedural period. Results: A total of 182 patients (78% women) were included. The median age at diagnosis was 33 years. 110 (60%) were secondary APS. In a median follow up of 108.5 months (9 years) were 71 (39%) second thrombosis with a median time of rethrombosis of 78 months (6.5 years) and an 8% of annual rethrombosis rate. In addition, there were 40 (22%) major bleeding episodes with a median time of bleeding of 99.5 months (8 years) and a 5% annual major bleeding rate. Also, 97 (53%) patients required one or more IP. A total of 216 IP were documented, 144 (67%) needed hospitalization. During the posterior 30 days post procedure we identified 9 (4%) major bleeding events and 3 (1%) of rethrombosis, in an extended period of 90 days there were no more bleeding events and 3 more episodes of rethrombosis. Being subjected to an IP was associated with a second thrombotic event with an OR of 2.16 (1.17 - 3.99). Nevertheless, of the 71 second thrombosis in the cohort just 3 (4%) were present during the 30 days of the procedure while 6 (8%) were present in a period of 90 days post procedure. IP were associated with a major bleeding event with an OR of 7.1 (2.8 - 17.9) with 9 (22%) presented in the 30 days of the procedure, especially in major surgery with an OR of 12.4 (1.52 - 101.37). Summary/Conclusion: In patients with APS, being subjected to an IP was associated with major bleeding events, particularly during major surgery, maybe because of the use of bridging anticoagulation therapy that was used in all in hospital patients undergoing to IP, despite a second thrombotic event was also associated, this does not seem to be secondary to the invasive procedure, due to this complication rarely occurring in the periprocedural period, we stipulate this association was more because IP were necessary owing to a second thrombotic event. With this information we highlight the incremental risk of major bleeding with little or non major thrombotic risk.Keywords: Anticoagulation, Thrombosis, Antiphospholipid syndrome, Bleeding